title: Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network.
abstract: BACKGROUND
  Success in deep biliary cannulation via native ampullae of Vater is an accepted measure of competence in ERCP training and practice, yet prior studies focused on predicting adverse events alone, rather than success. Our aim is to determine factors associated with deep biliary cannulation success, with/ without precut sphincterotomy.
  
  
  METHODS
  The ERCP Quality Network is a unique prospective database of over 10,000 procedures by over 80 endoscopists over several countries. After data cleaning, and eliminating previously stented or cut papillae, two multilevel fixed effect multivariate models were used to control for clustering within physicians, to predict biliary cannulation success, with and without allowing "precut" to assist an initially failed cannulation.
  
  
  RESULTS
  13018 ERCPs were performed by 85 endoscopists (March 2007 - May 2011). Conventional (without precut) and overall cannulation rates were 89.8% and 95.6%, respectively. Precut was performed in 876 (6.7%). Conventional success was more likely in outpatients (OR 1.21), but less likely in complex contexts (OR 0.59), sicker patients (ASA grade (II, III/V: OR 0.81, 0.77)), teaching cases (OR 0.53), and certain indications (strictures, active pancreatitis). Overall cannulation success (some precut-assisted) was more likely with higher volume endoscopists (> 239/year: OR 2.79), more efficient fluoroscopy practices (OR 1.72), and lower with moderate (versus deeper) sedation (OR 0.67).
  
  
  CONCLUSIONS
  Biliary cannulation success appears influenced by both patient and practitioner factors. Patient- and case-specific factors have greater impact on conventional (precut-free) cannulation success, but volume influences ultimate success; both may be used to select appropriate cases and can help guide credentialing policies.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University of South Carolina, 25 Courtenay Drive, ART 7100A, Charleston, SC 29425, USA. romagnuo@musc.edu.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Peng
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.forename: Peter B
authors.initials: PB
authors.lastname: Cotton
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
mesh_terms: D002404:Catheterization / Q000706:statistics & numerical data*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D041781:Jaundice, Obstructive / Q000453:epidemiology; D016015:Logistic Models; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D016717:Sphincterotomy, Endoscopic / Q000706:statistics & numerical data